| NPI | 1447678438 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BONNIE RUSSELL Administrator 941-889-7440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME71572) |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2024-08-06 |