| NPI | 1013449263 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE KINMON Owner 561-425-2929 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO3007) |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2024-10-09 |