| NPI | 1164173027 |
|---|---|
| Former Legal Business Name | NA |
| Entity Type | Organization |
| Authorized Contact | LEWIS JACKSON BARWICK Co Owner 813-252-6114 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2022-01-12 |
| Last Update Date | 2023-10-05 |