| NPI | 1013669878 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD KUCHER Chief Regulatory Officer 727-824-8100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2022-01-24 |
| Last Update Date | 2024-10-17 |