| NPI | 1164912754 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENII MODISETTE Operations Manager 813-365-5680 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2018-05-22 |