| NPI | 1811137623 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RODNEY A WEST Manager Member 386-589-8719 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center Medical Specialty (Licence: FL CH8958) |
| Enumeration Date | 2009-03-06 |
| Last Update Date | 2009-03-06 |