| NPI | 1467977827 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAIMIE LOUSIE MICKEY Owner Physician 813-362-5748 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: FL ME103083) |
| Enumeration Date | 2017-08-07 |
| Last Update Date | 2020-10-11 |