| NPI | 1558770503 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICKY ENN Credentialing Specialist 863-232-5062 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA OS8157) |
| Enumeration Date | 2014-08-04 |
| Last Update Date | 2014-08-06 |