| NPI | 1528107760 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THEODORE EVANS Physician 305-255-3050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: FL BE0283224) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2020-08-22 |