| NPI | 1326668351 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIA FUSSEL Chief Operating Officer 904-800-6347 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2020-04-20 |
| Last Update Date | 2023-09-04 |