| NPI | 1518493667 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICENTE MACO Doctor 904-471-9633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: FL ME117467) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2017-05-11 |