| NPI | 1306242482 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN ERNEST MENGELBERG President 941-320-7952 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: FL DN12930) |
| Enumeration Date | 2014-11-17 |
| Last Update Date | 2014-11-17 |