NPI | 1972792133 |
---|---|
Entity Type | Organization |
Authorized Contact | LAWRENCE J. REIS Owner 407-847-2898 |
Organization Subpart ? | No |
Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL CH0001632) |
Additional Taxonomies | 302R00000X Health Maintenance Organization (Licence: FL CH0001632) |
Enumeration Date | 2007-10-23 |
Last Update Date | 2007-10-23 |