| NPI | 1508256108 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IKE I LEE Owner 863-402-0909 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: FL ME0072053) |
| Enumeration Date | 2015-02-03 |
| Last Update Date | 2015-02-03 |