| NPI | 1053764985 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY WADE Administrator 407-445-9545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine |
| Enumeration Date | 2016-07-15 |
| Last Update Date | 2016-07-15 |