| NPI | 1467027045 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENEANE M. WAKULA Office Manager 772-546-9591 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC0050X Clinic/Center, Critical Access Hospital |
| Enumeration Date | 2021-05-25 |
| Last Update Date | 2021-05-25 |