| NPI | 1073863718 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATERIKA WILLIAMS Chief Executive Officer 407-687-3105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2012-09-10 |
| Last Update Date | 2012-09-10 |