| NPI | 1801360995 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERICA LOUISE CUKRAS Credentialing Representative 954-993-0422 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2019-01-11 |
| Last Update Date | 2019-01-11 |