| NPI | 1902054554 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE SIZEMORE Practice Administrator 407-647-2550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL 28144) |
| Enumeration Date | 2008-09-08 |
| Last Update Date | 2012-06-15 |