| NPI | 1306015672 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY LEE DIPPENWORTH President 321-303-5946 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: FL AP2518) |
| Enumeration Date | 2008-02-21 |
| Last Update Date | 2009-02-19 |