| NPI | 1437504016 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GUSTAVO PRADA Medical Director 239-300-6150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: FL ME120490) |
| Enumeration Date | 2016-05-02 |
| Last Update Date | 2016-05-02 |