| NPI | 1861840654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DWIGHT SANJUAN President 813-876-4370 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL B15486) |
| Enumeration Date | 2016-06-02 |
| Last Update Date | 2016-06-02 |