| NPI | 1912653551 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAMAINE MYERS Office Manager 863-732-1355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 251K00000X Public Health or Welfare |
| 261QH0100X Clinic/Center Health Service | |
| 305S00000X Point of Service | |
| Enumeration Date | 2022-02-22 |
| Last Update Date | 2022-02-22 |