| NPI | 1851663199 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON SPRINKLE Manager 765-465-3203 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: FL OTA7656) |
| Enumeration Date | 2012-02-02 |
| Last Update Date | 2012-02-02 |