| NPI | 1477885606 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA M ILARIA President 904-540-5709 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: FL f09000000292) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: FL f09000000292) |
| 251K00000X Public Health or Welfare (Licence: PA 3659481) | |
| Enumeration Date | 2010-02-15 |
| Last Update Date | 2010-02-15 |