| NPI | 1073059812 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSA L ESTELA FLINT Owner 321-289-2818 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: FL SW 6112) |
| Additional Taxonomies | 251S00000X (Licence: FL RN 893792) |
| Enumeration Date | 2017-01-18 |
| Last Update Date | 2017-01-18 |