| NPI | 1144561234 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE W IBRAHIM Dir 863-386-9122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: FL me0031535) |
| Enumeration Date | 2013-03-14 |
| Last Update Date | 2021-07-07 |