NPI | 1417377813 |
---|---|
Entity Type | Organization |
Authorized Contact | FRANK MAZZEO President/CEO 239-278-3600 |
Organization Subpart ? | No |
Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
Additional Taxonomies | 3336C0002X Pharmacy, Clinic Pharmacy (Licence: FL PH29774) |
Enumeration Date | 2014-04-24 |
Last Update Date | 2022-06-21 |