| NPI | 1831233816 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JIMMY C DICKERT Direct Owner 352-795-0644 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 0958010001) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2009-01-07 |