| NPI | 1053652099 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT ROBERT MICHAELS Owner 904-823-8833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: FL ME106486) |
| Enumeration Date | 2013-03-14 |
| Last Update Date | 2013-07-08 |