| NPI | 1700176732 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NAKESHA SHONEASE YOUNG Owner 863-595-6212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL 001447200) |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2011-04-11 |