| NPI | 1174719629 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIE RAIME Doctor 386-754-0339 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME85010) |
| Enumeration Date | 2007-09-19 |
| Last Update Date | 2012-12-11 |