| NPI | 1013474063 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL THEODORE BROWN Owner 863-276-0607 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2019-02-26 |
| Last Update Date | 2019-04-23 |