| NPI | 1205867975 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANITA ROBERTA WONGCHANTARA Owner/President 727-823-1111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: FL ME0076151) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2020-08-22 |