| NPI | 1922032515 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL MATTHEW GRAHAM Physician/Owner 407-774-4911 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME46929) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2020-08-22 |