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 |