| NPI | 1164724340 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PEGGIE CALAHAN Billing 772-569-3212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: FL ME103068) |
| Enumeration Date | 2010-11-22 |
| Last Update Date | 2012-04-05 |