| NPI | 1225385214 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WARRENRINA LA'TARA HENDERSON Owner/ Administrator 904-551-5046 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services (Licence: FL AL12180) |
| Enumeration Date | 2012-08-08 |
| Last Update Date | 2012-08-08 |