| NPI | 1720615693 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA LYNN ESPINAL COO 772-307-9840 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2024-03-25 |