| NPI | 1063097962 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSE A QUEZADA Director Of Network Development 407-588-7835 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2021-03-11 |
| Last Update Date | 2021-03-11 |