| NPI | 1174674956 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARSHA VENDETTI Operations Manager 321-722-5970 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2020-08-22 |