| NPI | 1962879866 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MORIAH MOFFITT Medical Director 813-871-2929 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: FL 606402) |
| Enumeration Date | 2015-08-26 |
| Last Update Date | 2015-08-26 |