| NPI | 1487985610 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAZARO GONZALEZ Owner 239-313-6300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: FL MM24026) |
| 207Q00000X Family Medicine | |
| Enumeration Date | 2010-01-28 |
| Last Update Date | 2021-02-10 |