| NPI | 1366742298 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARMEN C HIDALGO Office Manager 305-279-2767 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL CH6410) |
| Enumeration Date | 2010-10-26 |
| Last Update Date | 2013-03-27 |