| NPI | 1619921301 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUCILLE ANN VANDEVERE Owner 772-873-1005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: FL ARNP 3283142) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2020-08-22 |