| NPI | 1063671683 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID S BALLESTAS Doctor Owner 941-629-9190 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL ME0044391) |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2008-06-09 |