| NPI | 1841415932 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT WILCOX WILSON Owner 239-598-5750 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: FL 0s0006131) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2020-08-22 |