| 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 |