| NPI | 1073842456 |
|---|---|
| Doing Business As | 12TH AVENUE PEDIATRICS |
| Entity Type | Organization |
| Authorized Contact | CHANDRA SMILEY Executive Director 850-436-4630 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2009-12-15 |
| Last Update Date | 2018-11-30 |