| NPI | 1275711889 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAESEN PETRETTA Owner/Partner 239-839-3408 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: FL OT10199) |
| Enumeration Date | 2008-02-06 |
| Last Update Date | 2008-02-06 |