| NPI | 1417498031 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA BLAYLOCK Office Manager 352-377-2022 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: FL ARNP9391209) |
| Enumeration Date | 2017-03-15 |
| Last Update Date | 2017-03-15 |