NPI | 1205159423 |
---|---|
Entity Type | Organization |
Authorized Contact | MICHELLE RENEE REILLO Director 904-271-1053 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: MD R080304) |
Enumeration Date | 2010-03-02 |
Last Update Date | 2010-03-02 |