| NPI | 1285059006 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDY SCHULTZ Independent Contractor 850-293-4211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: GA MSW005915) |
| Enumeration Date | 2014-03-03 |
| Last Update Date | 2014-03-03 |