| NPI | 1003311267 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANA FAIR President 321-282-1999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2018-03-28 |