| NPI | 1851702740 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REYNA Q BRAGG Dom Ap 941-301-6940 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health (Licence: FL 3445) |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2014-09-26 |