| NPI | 1912192931 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA B. BRADLEY President 561-676-2989 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: DC PRC13943) |
| Enumeration Date | 2007-09-12 |
| Last Update Date | 2007-09-12 |