| NPI | 1700126505 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY CHEN Authorized Official 305-628-6117 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2013-02-15 |
| Last Update Date | 2020-02-28 |