| NPI | 1295870830 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER RAE FAIRCLOTH Office Manager 904-824-7476 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME0066989) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2007-10-22 |