| NPI | 1871032466 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANUEL E LOPEZ Owner 904-707-5498 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL ME107153) |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2020-07-09 |