| NPI | 1801102843 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANET KIGHT PORTER President 772-221-1698 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: FL 231415) |
| Enumeration Date | 2010-08-27 |
| Last Update Date | 2016-10-21 |