| NPI | 1588800528 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MADELEYNE NADAL Owner 813-877-6900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: FL HCC7493) |
| Enumeration Date | 2008-12-22 |
| Last Update Date | 2018-07-19 |