| NPI | 1073558797 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADFORD RUSSELL ESTRA President 561-697-3131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: FL 2001-13437) |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2020-08-22 |