| NPI | 1215049614 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD COOPER President/Owner 772-562-3030 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: FL ME45770) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: FL hcc5552) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2010-05-11 |