| NPI | 1205026911 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA DIANE DAVIS President 352-247-0226 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: FL MA 46796) |
| Enumeration Date | 2007-07-29 |
| Last Update Date | 2007-07-29 |