| NPI | 1235901141 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWANDA HOLLOWAY Ur/Insurance Specialist 904-387-4661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| 251S00000X | |
| Enumeration Date | 2023-10-24 |
| Last Update Date | 2023-10-24 |