| NPI | 1487059309 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIM R LEFFLER Business Development 239-693-2330 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL TB6155) |
| Enumeration Date | 2014-11-04 |
| Last Update Date | 2014-11-04 |