| NPI | 1861754590 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH BRADY Medical Doctor 727-820-7992 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: FL ME37799) |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2012-07-26 |