| NPI | 1346719812 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOLINE J BLANC Owner 561-317-8454 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| Enumeration Date | 2018-11-14 |
| Last Update Date | 2018-11-15 |