| NPI | 1699041285 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY EAGLE Administrator 407-886-2050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: FL DN13576) |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2012-03-28 |