| NPI | 1023784188 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE J KINMON CEO 561-995-0229 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| Enumeration Date | 2021-08-19 |
| Last Update Date | 2024-10-09 |