| NPI | 1376900019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY COOPERSMITH Owner 386-503-7950 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty (Licence: FL 9242220) |
| Enumeration Date | 2016-01-26 |
| Last Update Date | 2016-02-08 |