| NPI | 1750683397 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS L HERRING President 386-775-0525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: FL ME 56568) |
| Enumeration Date | 2010-12-02 |
| Last Update Date | 2010-12-02 |