| NPI | 1386421097 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA CRAIG Director Of Billing 321-698-3446 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2023-09-14 |
| Last Update Date | 2023-10-11 |