| NPI | 1437728441 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDEY CLARKE LANDKROHN Provider Enrollment Specialist 904-244-3603 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2021-06-23 |
| Last Update Date | 2021-06-23 |