| NPI | 1679671200 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY M BLOCK Owner 407-678-6888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: FL ME90314) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: FL ME0061495) |
| 261QP2300X Clinic/Center, Primary Care (Licence: FL OS0007059) | |
| 261QP2300X Clinic/Center, Primary Care (Licence: FL ME0074034) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2013-01-28 |