| NPI | 1356794804 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS PORTER Program Director 352-273-7800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: FL DN22016) |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2016-07-20 |