| NPI | 1548750763 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL STEPHEN WEBSTER Medical Director 321-442-8009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: FL ME0067861) |
| Enumeration Date | 2018-05-14 |
| Last Update Date | 2018-05-14 |