| NPI | 1245671361 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERALD VIZZONE Physician 239-489-2290 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: FL OS11480) |
| Enumeration Date | 2013-07-17 |
| Last Update Date | 2013-07-17 |