| NPI | 1851034169 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAUREN ANTONIA HUMPHREYS President 850-814-2587 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2022-04-14 |
| Last Update Date | 2023-02-27 |