SPACE COAST FAMILY PRACTICE

GREEN BAY, WI
NPI1811099054
Entity TypeOrganization
Authorized ContactTHOMAS CHARLES BETKA
President
920-544-5868
Organization Subpart ?No
Primary Taxonomy261Q00000X 
(Licence: FL  ME88311)
Enumeration Date2006-09-01
Last Update Date2020-08-22
Business Address
SPACE COAST FAMILY PRACTICE
3067 WINDLAND DR
GREEN BAY, WI 54311-7574
Phone number: 920-544-5868
Mailing Address
SPACE COAST FAMILY PRACTICE
3067 WINDLAND DR
GREEN BAY, WI 54311-7574
Phone number: 920-544-5868
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