| NPI | 1346714797 |
|---|---|
| Doing Business As | BLACKSTONE MEDICAL GROUP LLC |
| Entity Type | Organization |
| Authorized Contact | DIANE RICCA Managing Partner/Owner 561-306-5383 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Enumeration Date | 2019-01-18 |
| Last Update Date | 2019-07-08 |