| NPI | 1972863868 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD L FULMORE Owner 321-948-1335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH10202) |
| Enumeration Date | 2012-05-24 |
| Last Update Date | 2015-01-15 |