| NPI | 1124372420 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILL INNOCENT Officer 561-290-4144 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: FL ME92937) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: FL ME93404) |
| Enumeration Date | 2012-11-08 |
| Last Update Date | 2012-11-08 |