I understand the information disclosed in this form may be subject to re-disclosure and may no longer be protected by HIPAA privacy regulations and the HITECH Act.
I understand the information disclosed in this form may be subject to re-disclosure and may no longer be protected by HIPAA privacy regulations and the HITECH Act.
6654 Collier Blvd Suite 104,
Naples, FL 34114
12431 Brantley Commons Ct, Fort Myers, FL 33907