| NPI | 1083945919 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC MILLER Owner 954-338-3962 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: FL ch5357) |
| Enumeration Date | 2010-01-15 |
| Last Update Date | 2010-01-15 |