| NPI | 1740475052 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES LEWIS FENLEY Owner 386-960-7830 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ME-122760) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine |
| Enumeration Date | 2007-09-10 |
| Last Update Date | 2018-07-26 |