| NPI | 1831028554 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORENZA BERNARD SIMMONS Owner 386-366-5296 |
| Organization Subpart ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2026-05-18 |
| Last Update Date | 2026-05-18 |