| NPI | 1174793376 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSIE C SWAIN Office Manager 386-238-7408 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME0045774) |
| Enumeration Date | 2008-03-04 |
| Last Update Date | 2008-03-04 |