| NPI | 1679017339 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY LOUISE MIMS Employee 727-322-3644 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: FL N16000011186) |
| Enumeration Date | 2016-12-14 |
| Last Update Date | 2016-12-14 |