| NPI | 1760695852 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MERRIANNE RENEE RUST Office Manager 904-564-4343 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME060414) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2020-08-22 |