| NPI | 1134717945 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LETA WASHINGTON CEO/Owner 904-480-6403 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2021-01-07 |
| Last Update Date | 2021-06-11 |