| NPI | 1417481177 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NEIL BONNARDEL Director Of Medical Services 754-218-2164 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2019-09-09 |