| NPI | 1396149688 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIE MAUDE SIMEON President/Director 786-239-2255 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2014-10-15 |
| Last Update Date | 2014-10-15 |