| NPI | 1588839609 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLISON L WAKELAND Billing Manager 941-216-3964 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: FL 1304) |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical |
| 261QA1903X Clinic/Center, Ambulatory Surgical | |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2018-12-04 |