| NPI | 1982815650 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE CAVANAUGH Billing Manager 386-274-5712 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: FL ME53344) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2007-09-10 |