| NPI | 1760663322 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEANA MARTINSON Billing Manager 941-735-3034 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: IL 071006828) |
| Enumeration Date | 2007-11-23 |
| Last Update Date | 2025-10-09 |