| NPI | 1790159507 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL CHRISTOPHER VIA Owner 941-724-4653 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: FL PT12074) |
| Enumeration Date | 2015-11-17 |
| Last Update Date | 2015-11-17 |