| NPI | 1790162261 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SOHANNE WESTON Owner 754-422-1640 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL AL12656) |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2015-05-04 |