| NPI | 1558734467 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEIDI PICKERING Owner/Doctor 813-948-1781 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: FL CH10645) |
| Enumeration Date | 2015-11-02 |
| Last Update Date | 2016-07-21 |