| NPI | 1316130594 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT COOLIDGE Agent/Representative 386-774-5211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: FL ME55087) |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2013-09-27 |