| NPI | 1487015947 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARSHIRAY GRIFFIN Manager 904-651-6533 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: FL L16000039692) |
| Enumeration Date | 2016-03-11 |
| Last Update Date | 2016-03-11 |