| NPI | 1871684613 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KUMAR RAJAGOPALAN VP 954-973-6111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: FL ME50454) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2020-08-22 |