| NPI | 1902028764 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN MARK LOVELL President 239-549-6333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NR0400X |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2020-08-22 |