| NPI | 1528203593 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEX KHROMOV President 386-742-4343 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: FL ME96564) |
| Additional Taxonomies | 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) (Licence: FL ME96564) |
| Enumeration Date | 2008-12-04 |
| Last Update Date | 2008-12-10 |