| NPI | 1457397499 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN ANTHONY FETCHERO President 904-278-3820 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2010-09-30 |