| NPI | 1518126192 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES SIDNEY EBY Medical Director 239-936-1145 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME15824) |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2008-06-09 |