| NPI | 1083913842 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IRENA MARIA ASSEFA Manager 386-329-3939 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: FL ME67444) |
| Enumeration Date | 2011-03-19 |
| Last Update Date | 2012-06-26 |