| 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 |