| NPI | 1992022313 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEMETRA BENNETT Owner 352-585-0768 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: FL 9164847) |
| Enumeration Date | 2010-04-25 |
| Last Update Date | 2010-04-25 |