| NPI | 1073271763 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA CRAIG Director Of Billing 321-698-3446 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2021-11-30 |
| Last Update Date | 2022-04-05 |