| NPI | 1881947406 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE BARKER TINSLEY Owner 772-567-9955 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL SW5919) |
| Enumeration Date | 2012-10-19 |
| Last Update Date | 2012-10-19 |