| NPI | 1821238882 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLYDE PETTAWAY Chairman Of The Board 305-409-1287 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL ME058) |
| Enumeration Date | 2009-03-03 |
| Last Update Date | 2009-03-03 |