| NPI | 1003110818 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN NELSON President 863-983-8391 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL ch9995) |
| Enumeration Date | 2011-01-08 |
| Last Update Date | 2013-01-25 |