| NPI | 1770516924 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DWIGHT TIU Owner 386-328-5437 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: FL ME 0075674) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2020-08-22 |