| NPI | 1780930149 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLIFFORD LEE THACKER Owner 941-388-7457 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: FL 70754) |
| Enumeration Date | 2012-08-03 |
| Last Update Date | 2012-08-17 |