| NPI | 1831499060 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VILMARY VAZQUEZ Credentialing Agent 407-656-7866 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: FL 30010964034) |
| Enumeration Date | 2010-10-21 |
| Last Update Date | 2010-10-21 |