| NPI | 1528111085 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ILENE BALLENTINE Office Manager 386-774-0401 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL me75141) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2015-01-12 |