NPI | 1194227652 |
---|---|
Entity Type | Organization |
Authorized Contact | GABRIELA WATTERS Director Of Compliance 941-243-4660 |
Organization Subpart ? | No |
Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
Enumeration Date | 2018-03-01 |
Last Update Date | 2018-03-17 |