| NPI | 1194024992 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD A BLY Managing Director 3057-358-3920 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL OS10451) |
| Enumeration Date | 2011-03-18 |
| Last Update Date | 2013-08-29 |