| NPI | 1104981398 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE LYNN VILLAVICENCIO LAZO Vice President 904-338-9500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME0046485) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2011-11-14 |