| NPI | 1730405796 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN FRANCIS COUGHLAN Owner 239-949-5585 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9102717) |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2011-07-18 |