| NPI | 1821378571 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER J KELLEY CEO, Treasurer 941-921-7788 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL pa9102629) |
| Enumeration Date | 2011-08-25 |
| Last Update Date | 2018-10-29 |