| NPI | 1518017896 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA CRAIG Business Office Manager 321-241-6834 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2023-10-09 |