| NPI | 1225564073 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE HENNE President 321-759-2562 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine |
| Additional Taxonomies | 261QS1000X Clinic/Center, Student Health (Licence: FL ME121120) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2017-06-06 |