| NPI | 1306974696 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBORAH PATTERSON WALKER Clinical Specialist V 386-236-1812 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2022-07-21 |