| NPI | 1619126323 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANUN DUSTIN PARK President 239-369-4155 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: FL OS8128) |
| Enumeration Date | 2008-09-17 |
| Last Update Date | 2008-11-24 |