| NPI | 1407349608 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEGAN FARELLA Billing Specialist 850-862-2154 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME55553) |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2018-06-12 |