| NPI | 1164830287 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTORIA REGINA MILLER Owner 352-383-0004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: FL AP1376) |
| Enumeration Date | 2014-08-01 |
| Last Update Date | 2014-08-01 |