| NPI | 1174892830 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNN H. DENNIS Office Administrator 386-326-0575 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: FL ME54477) |
| Enumeration Date | 2011-12-23 |
| Last Update Date | 2011-12-23 |