| 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 |