| NPI | 1700129756 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIN L INGA Administrator 772-299-4623 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: FL 1623692) |
| Enumeration Date | 2013-03-28 |
| Last Update Date | 2013-03-28 |