| NPI | 1619166568 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUZETTE AVA CHANDLER Managing Member Of LLC 352-250-3112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: FL OS8237) |
| Enumeration Date | 2007-10-17 |
| Last Update Date | 2007-10-17 |