| NPI | 1689078602 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SYDEL LEGRANDE Owner 813-443-0866 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: FL me47234) |
| Enumeration Date | 2014-10-20 |
| Last Update Date | 2015-02-16 |