| NPI | 1255740767 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANAH W LARSON Secretary, Practice Administrator 904-264-6977 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2014-08-08 |
| Last Update Date | 2014-08-08 |