| NPI | 1073542825 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDY BRYANT Office Manager 850-526-5437 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME40400) |
| Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health (Licence: FL 40400) |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2011-03-08 |