| NPI | 1538651112 |
|---|---|
| Former Legal Business Name | LEGACY ADVANCED HEALTH |
| Entity Type | Organization |
| Authorized Contact | PAMELA DIANA MANNING Owner/Practitioner 561-563-5446 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2018-05-31 |