| NPI | 1275141558 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAULA NECOLE NEAL Asst. Ad For Health Performance 239-745-4299 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Enumeration Date | 2020-07-22 |
| Last Update Date | 2020-09-29 |