| NPI | 1558966309 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEELAH CHAMPION Practice Administrator 954-463-4761 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2020-12-01 |
| Last Update Date | 2020-12-01 |