| NPI | 1972673184 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES HAMILTON BOONE Owner 321-409-8941 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: FL PA3525) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2008-04-20 |