| NPI | 1124331350 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY DECLUE Director, Provider Services 407-875-2080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology |
| Enumeration Date | 2010-07-16 |
| Last Update Date | 2015-03-03 |