| NPI | 1467607994 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATIE E DRAKE Owner 239-284-0416 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: FL OS9565) |
| Enumeration Date | 2008-11-25 |
| Last Update Date | 2015-05-22 |