| NPI | 1053614941 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS W BAIRD Owner 904-264-2988 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: FL CH2410) |
| Enumeration Date | 2010-12-15 |
| Last Update Date | 2010-12-15 |