| NPI | 1033925342 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN M WAGNER Owner 850-806-2440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2024-12-10 |
| Last Update Date | 2025-08-03 |