| NPI | 1235232273 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK EDWARD PULWERS President 904-215-9266 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME0076341) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME0068123) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2020-08-22 |