| NPI | 1518361393 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIE VALDES Administrative Coordinator 904-281-1066 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2014-10-22 |
| Last Update Date | 2014-10-22 |