| NPI | 1891251336 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH GIACOMO CFO 813-866-0930 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2019-02-20 |