| NPI | 1528473089 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA WILKS Owner/President 772-626-4484 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: FL ND 6950) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2014-06-24 |