| NPI | 1558805994 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YOLANDA FEDORA HOLMES Pharmacist 813-416-9439 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health (Licence: MD 24615) |
| Enumeration Date | 2016-12-04 |
| Last Update Date | 2016-12-04 |