| NPI | 1932516408 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PANITDA D TOOCHINDA President 407-913-2156 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: FL ME29981) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: FL ME29981) |
| 305S00000X Point of Service (Licence: FL ME29981) | |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2014-07-16 |