| NPI | 1972938710 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN BALKARAN Assistant Administrator 321-251-1837 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: FL 9837) |
| Enumeration Date | 2013-09-12 |
| Last Update Date | 2013-09-12 |