| NPI | 1487188058 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINE ANN HACKFORD Executive Director 321-724-1177 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2017-04-20 |
| Last Update Date | 2018-03-28 |