| NPI | 1669789483 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS LEE PENDERGRAST President 850-785-3426 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: FL OPC2933) |
| Enumeration Date | 2010-09-01 |
| Last Update Date | 2010-09-01 |