| NPI | 1811206964 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARIN LYNN RAYMOND Office Administrator 813-875-2655 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME32624) |
| Enumeration Date | 2010-10-06 |
| Last Update Date | 2010-10-06 |