| NPI | 1972821700 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MISSY FOTHERINGHAM Office Manager 863-386-9595 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine |
| Enumeration Date | 2010-05-04 |
| Last Update Date | 2014-03-25 |