| NPI | 1831543982 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GABRIELA WATTERS Director Of Compliance 941-243-4660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 207R00000X Internal Medicine | |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2018-03-17 |