| NPI | 1528115458 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA CRAIG Business Office Manager 321-952-9696 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2014-02-18 |