| NPI | 1487302857 |
|---|---|
| Doing Business As | PROVIDENCE PRIMARY CARE |
| Entity Type | Organization |
| Authorized Contact | TAKAYA LINNE JONES Manager/Owner 904-476-0966 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Enumeration Date | 2022-03-15 |
| Last Update Date | 2022-07-26 |