| NPI | 1942435920 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDFORD HALSEY KINNE Owner/Self 386-677-5600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS0006791) |
| Enumeration Date | 2009-05-20 |
| Last Update Date | 2009-05-20 |