| NPI | 1831778513 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MERCEDES CHANEL RILEY Administrator 863-510-1685 |
| Organization Subpart ? | No |
| Primary Taxonomy | 163WG0000X Registered Nurse, General Practice |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2021-04-07 |