| NPI | 1316309115 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COURTNEY CAVALL Owner 954-649-6592 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL 10216) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2016-05-02 |