| NPI | 1740706035 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLARK MCCOY President 352-214-7180 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: CO 0054001) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 0054001) |
| Enumeration Date | 2017-08-17 |
| Last Update Date | 2020-12-17 |