| NPI | 1477832566 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KERLINE THOMAS Program Administrator 407-716-9896 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2011-08-08 |
| Last Update Date | 2011-08-08 |