| NPI | 1700915204 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN SYMEONIDES Physician 386-569-5592 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine (Licence: FL ME83577) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2007-10-15 |