| NPI | 1366559080 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORY DOMAYER CFO 386-231-3909 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 208D00000X General Practice | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2021-03-03 |