| NPI | 1871930370 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT GREGORY CARLSON Manager 941-955-1815 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: FL ME51783) |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: FL ME51783) |
| Enumeration Date | 2013-05-24 |
| Last Update Date | 2013-05-24 |