| NPI | 1669562500 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY M GORDON President 386-734-9995 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: FL CH7770) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2010-10-29 |