| NPI | 1982904579 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAINA MARIE PROCTOR Provisiospeech Language Pathologist 786-246-2046 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: FL sz 5252) |
| Enumeration Date | 2010-10-28 |
| Last Update Date | 2010-10-28 |