| NPI | 1831408954 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER L CONNELLY Office Manager 813-933-2841 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: FL 0S4309) |
| Enumeration Date | 2010-10-07 |
| Last Update Date | 2014-03-12 |