| NPI | 1235286527 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA JANE HAYNES Office Manager 904-783-3700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: FL OS7282) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2012-12-17 |