| NPI | 1407273410 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIGUEL RIVERA Physician 239-489-2290 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: FL ME109841) |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2014-03-27 |