NPI | 1104342443 |
---|---|
Entity Type | Organization |
Authorized Contact | CLARK MCCOY President 352-214-7180 |
Organization Subpart ? | No |
Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine (Licence: CO 0054001) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 0054001) |
Enumeration Date | 2017-08-18 |
Last Update Date | 2020-12-17 |