| NPI | 1215460290 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER DIVINE Owner 813-765-8453 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: CO DR.0058205) |
| Enumeration Date | 2017-04-06 |
| Last Update Date | 2017-04-06 |