| NPI | 1740671866 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDUARDO LEON President 754-816-5158 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: FL PH28882) |
| Enumeration Date | 2015-02-11 |
| Last Update Date | 2015-02-11 |