| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 550 E. Dixie Ave, Leesburg, Florida |
| Authorized Official Name and Position | Diane Harden (CFO) |
| Authorized Official Contact | 3523235762 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
550 E. Dixie Ave Leesburg FL 34748 Ph: (352) 323-2273 | 550 E. Dixie Ave Leesburg FL 34748 Ph: (352) 323-2273 |
| NPI Number | 1821408840 |
|---|---|
| Provider Enumeration Date | 04/29/2014 |
| Last Update Date | 04/29/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821408840 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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