| NPI | 1750617999 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVINA CRUSHANK BROWN Director 305-457-7598 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: FL ISW4315) |
| Enumeration Date | 2009-10-22 |
| Last Update Date | 2009-10-22 |