| NPI | 1487094983 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAESEN PETRETTA President 239-839-3408 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0400X Clinic/Center, Rehabilitation (Licence: FL ot10199) |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2013-06-28 |