| NPI | 1164579991 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HECTOR ROSA Manager 941-475-4809 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: FL L04000093281) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2020-08-22 |