| NPI | 1316399751 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNY GOODRICH CEO 786-317-2526 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: FL MH5842) |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2016-07-11 |