| NPI | 1114914777 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID OTTO Doctor / President 904-272-6886 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: FL CH8245) |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2008-03-11 |