| NPI | 1093086563 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAT THOMAS TIDWELL President 850-678-6735 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services (Licence: FL ME30890) |
| Enumeration Date | 2012-01-16 |
| Last Update Date | 2018-12-12 |