| NPI | 1073121232 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GILLIAN A ELLIS Owner/Provider 407-963-0125 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2020-07-14 |
| Last Update Date | 2020-07-14 |