| NPI | 1003674292 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERICA CLIPPS Provider 813-317-1787 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2024-03-12 |
| Last Update Date | 2024-03-12 |