| NPI | 1386940013 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANUNPORN SRISAWAT Managing Member 386-304-2990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: FL ME 95967) |
| Enumeration Date | 2011-01-27 |
| Last Update Date | 2011-10-12 |