| NPI | 1487312823 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICIA WHITE Credentialing Specialist 352-505-6363 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2021-12-02 |
| Last Update Date | 2021-12-02 |