| NPI | 1396365409 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDSEY RACHELLE PORTH Owner/Practitioner 772-206-2262 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2020-04-17 |
| Last Update Date | 2023-12-29 |