| NPI | 1154738946 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE KINMON Owner 561-369-2199 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| Enumeration Date | 2014-07-14 |
| Last Update Date | 2024-10-09 |