| NPI | 1053360669 |
|---|---|
| Doing Business As | PEDIATRICS AND ADOLESCENT MEDICINE |
| Entity Type | Organization |
| Authorized Contact | ABDUL KHALIL WALLIZADA Owner 904-276-0005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics Adolescent Medicine (Licence: FL ME0067026) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2008-07-07 |