| NPI | 1952782575 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA HACKEL President 850-916-3724 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: FL ME91174) |
| Enumeration Date | 2015-06-10 |
| Last Update Date | 2015-06-10 |