| NPI | 1982101044 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK KING President 786-774-2246 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: FL ME135881) |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2021-07-07 |