| NPI | 1124472360 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FREDO SAINT CHARLES Partner 772-361-3051 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty |
| Enumeration Date | 2016-04-13 |
| Last Update Date | 2016-04-13 |