| NPI | 1104058866 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY CHERYL BRAVERMAN Speech Language Pathologist 239-282-3814 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: FL SA6013) |
| Enumeration Date | 2009-08-13 |
| Last Update Date | 2009-08-13 |