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 |