| NPI | 1871073122 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DACELIN ST MARTIN Medical Director / Owner 352-527-6888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2018-08-16 |
| Last Update Date | 2018-08-16 |