| NPI | 1376977611 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY L JOHN President 904-272-5855 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: FL CH9007) |
| Enumeration Date | 2013-08-22 |
| Last Update Date | 2013-08-22 |