| NPI | 1952876724 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH LARSON Practice Administrator 239-265-3391 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine Adult Medicine |
| Enumeration Date | 2018-10-09 |
| Last Update Date | 2021-09-03 |