| NPI | 1083913776 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHON PENDERGRASS Owner 251-631-3534 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: AL 12457) |
| Enumeration Date | 2011-03-21 |
| Last Update Date | 2011-03-21 |