| NPI | 1588820989 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK G COULTER Owner 786-331-7055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: FL DN16954) |
| Enumeration Date | 2008-08-05 |
| Last Update Date | 2008-08-05 |