| NPI | 1962893156 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID JOSEPH BLACK Owner 352-375-6708 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: FL meoo44628) |
| Enumeration Date | 2015-02-10 |
| Last Update Date | 2015-02-10 |