| NPI | 1689983389 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDMUND CHARLES WEIDNER Owner 239-263-5400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: FL me0038533) |
| Enumeration Date | 2010-09-29 |
| Last Update Date | 2010-09-29 |