| NPI | 1043494479 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EBON ANTHONY BOURNE Md/Owner 954-895-8240 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty (Licence: GA 68373) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME84326) |
| Enumeration Date | 2007-12-20 |
| Last Update Date | 2015-03-20 |