| NPI | 1750668059 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS DOUG CLARK Clinic Coordinator 239-591-1488 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1800X Clinic/Center, Corporate Health |
| Enumeration Date | 2011-11-15 |
| Last Update Date | 2011-11-15 |