| NPI | 1891991238 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSE D TIPPETT Owner 727-376-3547 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME93868) |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2016-07-12 |