| NPI | 1780955997 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM BARTHOLOMEW POWERS Owner 727-541-0323 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: FL OS6697) |
| Enumeration Date | 2012-01-19 |
| Last Update Date | 2024-11-22 |