| NPI | 1134947138 |
|---|---|
| Former Legal Business Name | JCW WELLNESS CLINIC LLC |
| Entity Type | Organization |
| Authorized Contact | WISLEY CASANOVA MORENO Owner 786-695-2202 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Enumeration Date | 2024-09-30 |
| Last Update Date | 2024-10-01 |