| NPI | 1023684107 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHEL TERRELONGE Board Director 813-407-1809 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2021-05-31 |
| Last Update Date | 2021-05-31 |