| NPI | 1417650714 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARA LARSON HUSSAIN Owner Administrator 813-957-8730 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2023-03-24 |
| Last Update Date | 2023-03-24 |