NPI | 1053077123 |
---|---|
Entity Type | Organization |
Authorized Contact | AMARILYS CORTES-MORA Business Administrator 407-207-1800 |
Organization Subpart ? | No |
Primary Taxonomy | 305R00000X Preferred Provider Organization |
Enumeration Date | 2021-11-12 |
Last Update Date | 2021-11-12 |