| NPI | 1518330273 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENEANE MARIE WAKULA Office Manager 772-546-9591 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: DE C2-0010908) |
| Enumeration Date | 2015-11-03 |
| Last Update Date | 2015-11-03 |