| NPI | 1508181272 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA DISTEFANO President 352-262-5625 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL HCC8936) |
| Enumeration Date | 2010-04-06 |
| Last Update Date | 2021-07-29 |