| NPI | 1265667448 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY C LU Billing/Credentialing Specialist 904-221-2535 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME88142) |
| Enumeration Date | 2009-05-18 |
| Last Update Date | 2012-06-21 |