| NPI | 1265673271 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OWEN DELROY FRASER Owner 407-578-9142 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: FL ME30256) |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services (Licence: FL ME30256) |
| Enumeration Date | 2009-03-20 |
| Last Update Date | 2009-03-20 |