| NPI | 1407263833 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIN ANN HENNINGS Owner 772-486-7427 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: FL ARNP9235485) |
| Enumeration Date | 2014-07-17 |
| Last Update Date | 2014-07-17 |