| NPI | 1487817136 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA HOPE DUNN Cna 772-971-4848 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL 131357) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2008-07-02 |