| NPI | 1801314190 |
|---|---|
| Former Legal Business Name | N/A |
| Entity Type | Organization |
| Authorized Contact | DAVID BOASC Precident 305-510-1190 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL hcc11133) |
| Enumeration Date | 2017-09-06 |
| Last Update Date | 2022-07-21 |