| NPI | 1366807562 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINE G. VARNER Executive Director 239-213-9370 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: FL AL 12760) |
| Enumeration Date | 2015-12-15 |
| Last Update Date | 2015-12-15 |