| NPI | 1356681845 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROGER DAVID SUARES Medical Director 863-688-9219 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: FL ME0043239) |
| Enumeration Date | 2013-02-21 |
| Last Update Date | 2013-02-21 |