| NPI | 1518341932 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES C. MISSO Owner 850-926-3062 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: FL jb4895) |
| Additional Taxonomies | 302R00000X Health Maintenance Organization (Licence: FL jb4895) |
| Enumeration Date | 2015-07-15 |
| Last Update Date | 2015-07-15 |