Organization
ED MEDICAL THERAPY CENTER, INC.
Active
Other names
ED MEDICAL THERAPY CENTER, INC.
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JANIS GOMEZ X PRESIDENT (PRESIDENT)
(813) 407-1591
Entity
Organization
Contact information
Practice address
4311 W WATERS AVE, SUIT #205, TAMPA, FL 33614
(813) 407-1591
Mailing address
4311 W WATERS AVE, SUITE 205, TAMPA, FL 33614
(813) 407-1591
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
HCC9274
FM
Other
Enumeration date
10/14/2011
Last updated
05/05/2015
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