| NPI | 1215151451 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY M DOWBAK Medical Doctor 239-498-4910 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: FL 43416) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2020-08-22 |