| NPI | 1215167135 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MACEO B POWELL Owner 941-927-5913 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: FL CH-7710) |
| Enumeration Date | 2009-07-27 |
| Last Update Date | 2011-07-07 |