| NPI | 1225077241 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARA L OLSON Credentialing 941-758-4608 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: FL 1033) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2020-01-03 |