| NPI | 1205824794 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JON I LEVIN Owner 863-494-6694 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL 057941) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL 057941) |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2007-11-01 |