| NPI | 1497198816 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD ROUSSEAU Chief Administrative Officer 772-266-7682 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2018-08-09 |