| NPI | 1982268322 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEANNA FOTHERINGHAM Mgr/Authorized Official 863-253-7928 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2019-04-30 |
| Last Update Date | 2024-04-08 |