| NPI | 1023033669 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN ERIC JORDAN Gm/President 772-778-2101 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: FL HCC6082) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2012-01-03 |