| NPI | 1891293668 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE PETERSEN President 305-846-9303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 261QR0400X Clinic/Center, Rehabilitation |
| Enumeration Date | 2018-01-26 |
| Last Update Date | 2018-01-26 |