| NPI | 1104584689 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICIA WHITE Credentialing Specialist 352-505-6363 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2021-12-02 |
| Last Update Date | 2022-07-13 |