| NPI | 1295910834 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE L JACKSON Office Manager 386-761-0050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME0028054) |
| Enumeration Date | 2008-01-02 |
| Last Update Date | 2011-03-29 |