| NPI | 1982101309 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JODI DESPOY Manager 813-228-6334 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2023-06-26 |