| NPI | 1609013754 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLANNE PATRIACO Executive Director 813-290-8560 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL 90843) |
| Enumeration Date | 2009-01-12 |
| Last Update Date | 2009-01-12 |