| NPI | 1346349958 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYMOND JEFFREY HULLEY President 772-781-2207 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2012-10-28 |