| NPI | 1720351695 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH SEBASTIAN MADDOX Owner 727-392-1465 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: FL 3204) |
| Enumeration Date | 2012-02-22 |
| Last Update Date | 2012-02-22 |