| NPI | 1639163975 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA FAUCETT Administrator 321-409-9990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology |
| Enumeration Date | 2005-09-01 |
| Last Update Date | 2024-04-23 |