| NPI | 1790090538 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN D FLAGEL Owner/Operator 941-429-3545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: FL ME 107190) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: FL OS 10992) |
| Enumeration Date | 2010-08-17 |
| Last Update Date | 2017-03-28 |