| NPI | 1689972200 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MYLAINE RIOBE HERON Owner/Director 772-266-4258 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center Medical Specialty (Licence: FL ME82630) |
| Enumeration Date | 2011-03-06 |
| Last Update Date | 2012-04-02 |