| NPI | 1083882872 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TASHANNA CALDWELL Administrator 954-793-3379 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL 06000097) |
| Enumeration Date | 2008-02-14 |
| Last Update Date | 2008-02-14 |