| NPI | 1366942013 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GABRIELA WATTERS Director Of Compliance 941-243-4660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2018-02-20 |
| Last Update Date | 2018-03-17 |