| NPI | 1760776900 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURENCE THOMAS HREN C Eo 863-676-1770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2025-01-08 |