| NPI | 1669644316 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROY PETER CARLSON Owner 407-770-0038 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: FL 305ROOOOOX) |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2008-04-01 |