| NPI | 1629476098 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIA A DEJESUS Office Manager 321-615-1417 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME118141) |
| Enumeration Date | 2014-12-16 |
| Last Update Date | 2020-10-13 |