| NPI | 1023405065 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID THIEL Department Chair 904-953-7330 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center Medical Specialty (Licence: FL PA 3550) |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2015-04-16 |