| NPI | 1558446047 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI MARTELL Practice Administrator 239-254-3104 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: FL ARNP 9243964) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2020-08-22 |