| NPI | 1831365493 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRISTIAN BALSERA Owner 813-571-3777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: FL ME78809) |
| Enumeration Date | 2008-05-05 |
| Last Update Date | 2008-05-05 |