| NPI | 1982248134 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW CLAY CEO 352-732-6599 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| 208D00000X General Practice | |
| Enumeration Date | 2019-10-31 |
| Last Update Date | 2023-02-08 |