| NPI | 1356656813 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUNITA BACCHUS Billing Manager 352-854-5530 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS0004310) |
| Enumeration Date | 2010-08-09 |
| Last Update Date | 2017-12-06 |