| NPI | 1326090390 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRANK S MAZZEO President CEO 239-278-3600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: FL PH7923) |
| 3336C0002X Pharmacy, Clinic Pharmacy (Licence: FL PH7923) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2022-05-18 |