| NPI | 1013265719 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FARID MOGHADASI Owner 863-858-7600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL DN13330) |
| Enumeration Date | 2012-08-28 |
| Last Update Date | 2015-02-19 |