| NPI | 1073813630 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSANA T DONAIRE Medical Doctor 352-564-8620 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME#0045956) |
| Enumeration Date | 2010-10-29 |
| Last Update Date | 2012-01-23 |