| NPI | 1841834827 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMAR D GORENYUK Compliance Officer 239-343-1912 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 302R00000X Health Maintenance Organization |
| Enumeration Date | 2019-11-01 |
| Last Update Date | 2019-11-01 |