| NPI | 1780962027 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDALL WILDS Owner 407-275-9335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NR0400X |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine |
| Enumeration Date | 2011-08-03 |
| Last Update Date | 2015-06-08 |