| NPI | 1316331952 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUBINA WEST Pharmacy Technician 727-204-0376 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QV0200X Clinic/Center, VA (Licence: FL RPT 52320) |
| Additional Taxonomies | 261QV0200X Clinic/Center, VA (Licence: DC 10032382) |
| Enumeration Date | 2015-03-20 |
| Last Update Date | 2015-03-20 |