| NPI | 1659698371 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANNA L BRICK Practice Manager 813-689-2054 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME0046345) |
| Enumeration Date | 2010-04-21 |
| Last Update Date | 2023-03-07 |