| NPI | 1700039161 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXANDRA MARION PAMELA KOSTICK Director 386-446-9590 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME63389) |
| Enumeration Date | 2008-10-29 |
| Last Update Date | 2008-10-29 |