| NPI | 1639901440 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH KIRBY Owner 813-731-6464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QC1500X Clinic/Center Community Health |
| Enumeration Date | 2024-08-19 |
| Last Update Date | 2025-05-21 |