| NPI | 1578965653 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANA D DAMERON Managing Member 772-800-3037 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS11959) |
| Enumeration Date | 2014-09-21 |
| Last Update Date | 2020-12-09 |