| NPI | 1417760372 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA RILEY Billing Manager 850-215-3578 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2025-01-27 |
| Last Update Date | 2025-01-27 |