| NPI | 1457893869 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLINE BLANKE Owner 561-601-0999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL AP3774) |
| Enumeration Date | 2016-11-16 |
| Last Update Date | 2017-03-01 |