| NPI | 1437542909 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBBIE ADCOCK Assistant Manager 850-457-3753 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL ME0039494) |
| Enumeration Date | 2015-03-09 |
| Last Update Date | 2015-03-09 |