| NPI | 1689817918 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH M DEGRAAF Owner/Provider 727-359-3779 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME85861) |
| Enumeration Date | 2009-04-16 |
| Last Update Date | 2009-06-11 |