| NPI | 1235629742 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLIE LYNN WELLS Office Manager 207-942-4653 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: ME MD9794) |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2018-05-10 |