| NPI | 1841316312 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CINDY K VANZUUK Office Manager Credential Dept 386-445-6191 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS5359) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2008-06-11 |