| NPI | 1376095729 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTONIETTA GUZMAN Office Manager 904-374-0260 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: FL 207L00000X) |
| Enumeration Date | 2016-11-02 |
| Last Update Date | 2016-11-02 |