| NPI | 1861687618 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE MICHAEL BRIDEWELL President 239-992-7822 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: FL ME51156) |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2013-03-01 |