| NPI | 1609442375 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDALL MARK BURGAN Chief Operating Officer 727-498-4807 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2021-06-02 |
| Last Update Date | 2021-06-04 |