| NPI | 1720359045 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY R JACOBS Owner 352-596-4482 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: FL OS0007621) |
| Enumeration Date | 2012-01-18 |
| Last Update Date | 2012-07-02 |