| NPI | 1972812865 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH W TRUSSELL President/Owner 813-685-4222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: FL 6246) |
| Enumeration Date | 2010-09-27 |
| Last Update Date | 2010-09-27 |