| NPI | 1972618197 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ILEANA BRACETE SOSA Administrator 239-466-0600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME59779) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2012-10-25 |