| NPI | 1033534326 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN VALENZUELA ESTARES Adminstrator 850-384-7656 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: FL 6906454) |
| Enumeration Date | 2014-02-24 |
| Last Update Date | 2014-02-24 |