| NPI | 1235416322 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN E MOORE Owner 904-387-6116 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME39355) |
| Enumeration Date | 2011-11-03 |
| Last Update Date | 2012-01-09 |