| NPI | 1811940471 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAWRENCE ALLEN FOSSITT President 407-328-5420 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty (Licence: FL PT 19048) |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty (Licence: FL OT 10292) |
| 261QM1300X Clinic/Center Multi-Specialty (Licence: FL SA 1721) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2012-01-17 |