| NPI | 1487925814 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAUDEL LA O President 786-334-6170 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: FL HCC9690) |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2012-01-17 |
| Last Update Date | 2015-03-17 |