| NPI | 1629338736 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTIAN ELLIS Medical Director 239-404-6641 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: FL ME101183) |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2012-05-22 |