| NPI | 1679531164 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE C DAVIS Assistant Manager 239-513-1992 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2009-02-09 |