| NPI | 1417121690 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD H TIETJEN President 561-358-8462 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: FL HCC6776) |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2008-04-17 |