| NPI | 1699315499 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER A BLAKE Owner 954-557-2775 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP3300X Clinic/Center, Pain |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| 261QM2500X Clinic/Center, Medical Specialty | |
| Enumeration Date | 2020-01-09 |
| Last Update Date | 2020-06-11 |