| NPI | 1710219167 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSANNA CRAWFORD Owner 772-569-9729 |
| Organization Subpart ? | No |
| Primary Taxonomy | 293D00000X Physiological Laboratory |
| Additional Taxonomies | 261QR0208X Clinic/Center, Radiology, Mobile (Licence: FL HCC5034) |
| Enumeration Date | 2010-02-10 |
| Last Update Date | 2013-02-27 |