| NPI | 1558916494 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN DEVRIES Owner 727-600-8500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2019-08-07 |
| Last Update Date | 2026-01-07 |