| NPI | 1225634462 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLAYTON COVELL LANCASTER Project Manager 850-758-8331 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2020-12-10 |
| Last Update Date | 2021-01-21 |