| NPI | 1073069191 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMALA A ALLEN Owner/ L.M.T. 850-426-4158 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: FL MA 62968) |
| Enumeration Date | 2016-08-29 |
| Last Update Date | 2016-09-01 |