| NPI | 1831623867 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SIMEON SHEPARD Owner 386-566-1949 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: FL 119725) |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2017-04-17 |