| NPI | 1235398058 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA BRADLEY President 727-532-1355 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME89948) |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2008-07-03 |