| NPI | 1366750028 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON LEE NIERMAN Owner/Manager 904-527-9601 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: IN 08002640A) |
| Enumeration Date | 2010-09-15 |
| Last Update Date | 2012-04-05 |