| NPI | 1881383941 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER L COCHRAN Owner/Provider 727-203-4417 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2023-05-04 |
| Last Update Date | 2023-05-04 |