| NPI | 1033215710 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY LEE FOUNTAIN Director 321-331-4253 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2025-07-21 |