| NPI | 1588705768 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDI LAROCHE Mso Credentialing COO Rdinator 321-449-4168 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2008-08-26 |