| NPI | 1942242441 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROL J FANNING Office Manager 772-299-1404 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: FL 1198) |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2014-06-09 |