| NPI | 1720446792 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS A GRESHAM Owner 239-495-2020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: FL OPC1224) |
| Enumeration Date | 2016-02-05 |
| Last Update Date | 2016-02-05 |