| NPI | 1821416488 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA MOORE Owner 772-220-0033 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL ARNP9166216) |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2014-04-01 |