| NPI | 1518072826 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRAIG ALLAN MILLER Owner/President 386-852-3652 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS7698) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2014-10-21 |