| NPI | 1528345873 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES LEE CLAY CLAY Managing Partner 813-908-5658 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: FL OS0007192) |
| Enumeration Date | 2011-11-14 |
| Last Update Date | 2012-06-24 |