| NPI | 1053088724 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILLIAN SCHELLHAMMER Credentialing Specialist 904-800-6347 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2021-08-30 |
| Last Update Date | 2021-08-30 |