| NPI | 1134336209 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICKEL WRAY ANGLIN President 813-672-1385 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME91647) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2019-01-23 |