| NPI | 1952555039 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY ELISE DERROW Owner/Sole Provider 407-389-2020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME 100833) |
| Enumeration Date | 2008-11-16 |
| Last Update Date | 2008-11-16 |