| NPI | 1225771157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOUIS MAZZELLA Owner/Authorized Official 904-518-7127 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2022-04-19 |
| Last Update Date | 2024-04-25 |