| NPI | 1043633613 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL WILLIAM FORMISANO President 305-885-5180 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: FL ME91614) |
| Enumeration Date | 2014-02-01 |
| Last Update Date | 2014-02-01 |