| NPI | 1114398427 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOE A JACKSON Owner 850-469-1330 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL 85613) |
| Enumeration Date | 2015-10-13 |
| Last Update Date | 2015-10-13 |