| NPI | 1447447339 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY C. LU Credentialing Coordinator 904-221-2535 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME0064398) |
| Enumeration Date | 2007-09-25 |
| Last Update Date | 2014-02-28 |