| NPI | 1205548450 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER WAYNE LUCZYWO Practice Manager 407-307-1511 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QH0100X Clinic/Center Health Service |
| Enumeration Date | 2022-12-20 |
| Last Update Date | 2022-12-20 |