| NPI | 1851580740 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLENE A. MELLO Practice Manager 239-592-9666 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME0063724) |
| Enumeration Date | 2007-10-17 |
| Last Update Date | 2011-03-11 |