| NPI | 1659672715 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINA M HUST Director Of Operations 813-977-8700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 261Q00000X (Licence: FL 8522) |
| Enumeration Date | 2010-11-05 |
| Last Update Date | 2021-12-07 |