| NPI | 1346625522 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMILY JACKSON Physician 321-704-1807 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP1100X Clinic/Center, Podiatric (Licence: FL PO3484) |
| Enumeration Date | 2015-07-29 |
| Last Update Date | 2018-02-12 |