| NPI | 1336303353 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT LABOHN President 813-250-0616 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: FL PO1092) |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2022-12-28 |