| NPI | 1396918579 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNETTE WILLIAMS Owner 386-437-7977 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME61253) |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: FL ME61253) |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2017-03-07 |