| NPI | 1801224290 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSSE ANTHONY MAZO-MAYORQUIN Md/Owner 321-733-2711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME89659) |
| Enumeration Date | 2013-10-22 |
| Last Update Date | 2014-09-29 |