| NPI | 1386821957 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBORAH DAVIS-HILDERLEY Billing Representative 352-232-0470 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL MM20152) |
| Enumeration Date | 2008-01-26 |
| Last Update Date | 2008-01-30 |