| NPI | 1831655380 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH GIACOMO CFO 813-866-0930 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2024-07-30 |