| NPI | 1376548602 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMUEL SANTELICES President/ CEO 386-758-0003 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health (Licence: FL ME87551) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME87551) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: FL ME87551) | |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2021-09-08 |