NPI | 1114323631 |
---|---|
Entity Type | Organization |
Authorized Contact | REBECCA BURNSIDE Office Manager 904-826-7932 |
Organization Subpart ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME97900) |
Enumeration Date | 2014-11-11 |
Last Update Date | 2014-11-11 |