| NPI | 1104071943 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDY M WALDRON Billing Admin. 772-221-0190 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2008-11-20 |
| Last Update Date | 2008-11-20 |