| NPI | 1831175454 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDIE N MOSBY Front Supervisor 813-888-9924 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME0048476) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2007-10-30 |