| NPI | 1699220749 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEANNE MASCARO Director Of Mso 786-210-1896 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 171W00000X Contractor |
| Enumeration Date | 2016-08-18 |
| Last Update Date | 2023-11-08 |