| NPI | 1831258797 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CATALINA CARRERAS Administrator 239-793-3136 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: FL HCC4861) |
| Enumeration Date | 2006-12-07 |
| Last Update Date | 2020-08-22 |