| NPI | 1841589496 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACEY LEE ROBINSON Owner 727-773-6286 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: FL L10000018885) |
| Enumeration Date | 2011-04-05 |
| Last Update Date | 2011-08-01 |