| NPI | 1235431875 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY V. HANSBROUGH Director 772-287-7701 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: FL CH 3653) |
| Enumeration Date | 2010-12-02 |
| Last Update Date | 2010-12-02 |