| NPI | 1366762692 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA S SAFFY Office Manager/Medical Assistant 904-731-7830 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME 15492) |
| Enumeration Date | 2010-06-09 |
| Last Update Date | 2010-08-16 |