| NPI | 1932595741 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARLENE CAROL VANCE Practice Administrator 561-292-3747 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME114719) |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2023-10-26 |