| NPI | 1770698706 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WAYNE ISAACSON Md 239-939-7375 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: FL ME0071098) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2007-07-31 |