| NPI | 1083180434 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA CRAIG Director Of Billing 321-241-6834 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2018-10-23 |
| Last Update Date | 2018-10-26 |