| NPI | 1316694144 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARON G. DIECIDUE Member Manager 813-925-1903 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2022-03-02 |
| Last Update Date | 2022-03-02 |