| NPI | 1578644431 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM L. WARE Social Science Program Specialist 727-398-6661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: IL 1307) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2020-08-22 |