| NPI | 1679622120 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARSHA VENDETTI Operations Manager 321-722-5970 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2010-11-04 |