| NPI | 1821203035 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LILIVETTE ROLLAND Owner 813-727-3469 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL me59316) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2020-08-22 |