| NPI | 1558634048 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTIN JOSEPH MILNE Owner 727-669-6411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: FL me0076664) |
| Enumeration Date | 2012-02-15 |
| Last Update Date | 2012-02-15 |