| NPI | 1558402479 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA DEJESUS Manager 813-915-8666 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: FL 0038694) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2020-08-22 |