| NPI | 1376805168 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH PRIMM Office Manager 813-571-1111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: FL 36113183) |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2018-05-01 |