| NPI | 1932722162 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINA COOPER Director 305-528-2836 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 251B00000X Case Management |
| 332900000X Non-Pharmacy Dispensing Site | |
| Enumeration Date | 2020-05-21 |
| Last Update Date | 2021-05-07 |