| NPI | 1427432715 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASSANDRA HICKS Owner/President 772-216-6750 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: FL 9275760) |
| Enumeration Date | 2015-07-16 |
| Last Update Date | 2015-07-16 |