| NPI | 1083026470 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VENEKA UNDERWOOD Certified Nursing Assistant 386-288-3725 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2014-05-20 |
| Last Update Date | 2014-05-20 |