| NPI | 1235480823 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONISHIA CHAVONDA MILLER President 863-595-6153 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: FL 100025378) |
| Additional Taxonomies | 305S00000X Point of Service (Licence: FL 100024564) |
| Enumeration Date | 2012-09-24 |
| Last Update Date | 2012-09-24 |