| NPI | 1700196599 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD CHARLES CHILDERS President 352-331-0418 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL 0017669) |
| Enumeration Date | 2010-10-14 |
| Last Update Date | 2011-08-31 |