| NPI | 1770905937 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSE MARIE ALBATROSOV Owner 386-562-8213 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: FL BT-72927) |
| Enumeration Date | 2014-01-07 |
| Last Update Date | 2014-01-07 |