| NPI | 1235642711 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES BOLGER Owner 239-908-0899 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0400X Clinic/Center, Rehabilitation (Licence: FL ch11936) |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2017-11-07 |
| Last Update Date | 2017-11-07 |