| NPI | 1700140001 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERARD SPRAGUE Supervisor 239-332-8009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL 650848685) |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2012-07-02 |