| NPI | 1891075032 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID GRAFTON FANNEY Prisident 386-752-2246 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS0005960) |
| Enumeration Date | 2011-08-19 |
| Last Update Date | 2012-01-27 |