| NPI | 1831611516 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL WYCOKI Manager 772-467-2677 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: FL ME81066) |
| Enumeration Date | 2017-07-13 |
| Last Update Date | 2017-07-13 |