| NPI | 1114770336 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENDRA ARCHER Vice President, Board Secretary 813-206-1393 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2024-04-08 |
| Last Update Date | 2024-05-24 |