| NPI | 1306147590 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUDY ANNE NICKELS Office Manager 904-731-0304 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME71303) |
| Enumeration Date | 2010-11-04 |
| Last Update Date | 2010-11-08 |