| NPI | 1366811077 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBIN L MOSS Executive Director 850-431-6256 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty (Licence: FL 4080) |
| Enumeration Date | 2015-09-23 |
| Last Update Date | 2021-05-15 |