| NPI | 1285738369 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY KAY BURNS Administrator 863-993-4601 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251K00000X Public Health or Welfare |
| Additional Taxonomies | 1223G0001X Dentist General Practice |
| 207V00000X Obstetrics & Gynecology | |
| 208D00000X General Practice | |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2025-02-04 |