| NPI | 1164931457 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARRETT GREEN Owner 305-895-9551 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: FL 134641434936) |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2017-09-29 |
| Last Update Date | 2022-07-21 |