| NPI | 1477068195 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MERLAND BAKER Director 904-566-1955 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 251S00000X (Licence: FL 265852549) |
| Enumeration Date | 2017-12-04 |
| Last Update Date | 2018-06-16 |