| NPI | 1417237785 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARC E. MCCOLLAUM Managing Member 239-455-8048 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL 9102277) |
| Enumeration Date | 2011-08-18 |
| Last Update Date | 2011-08-18 |