| NPI | 1073721718 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WESLEY CHARLES WING Administrator 727-434-2115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: FL 7309) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2020-08-22 |