| NPI | 1912056540 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNNE M ELLIS President 727-822-5393 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: FL 46897) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2012-09-25 |