| NPI | 1306857776 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH MARIE KROCHAK Medical Doctor 386-673-5361 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME46477) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2020-08-22 |