| NPI | 1316599624 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KACEY A MONTGOMERY Regional Medical Director 850-791-6895 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2019-07-16 |
| Last Update Date | 2022-05-17 |