| NPI | 1891098612 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN ROSS WASSERMAN President 941-484-8222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: FL ME106806) |
| Enumeration Date | 2010-12-16 |
| Last Update Date | 2010-12-16 |