| NPI | 1689867418 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUDI RICHARDSON Controller 239-278-1155 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207NI0002X Dermatology Clinical & Laboratory Dermatological Immunology |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2007-08-24 |