| NPI | 1962813790 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANE E STAFFORD Manager 239-514-7734 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: FL ME38081) |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2014-05-14 |