| NPI | 1215180146 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW MOUNTAIN Manager 407-756-1051 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: FL OSR632) |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2008-10-23 |
| Last Update Date | 2008-10-28 |