| NPI | 1467876912 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARVIN R SPONAUGLE Owner 727-945-9198 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: FL ME45587) |
| Enumeration Date | 2014-02-04 |
| Last Update Date | 2014-02-04 |