| NPI | 1467820795 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY CHILDRESS Administrative Director 352-323-5665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2015-09-03 |
| Last Update Date | 2015-09-08 |