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 |