| NPI | 1215233184 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA FRIEDLEY Practice Administator 904-292-2700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME84002) |
| Enumeration Date | 2011-02-09 |
| Last Update Date | 2011-07-25 |