| NPI | 1538427166 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOVAN MILES Owner 904-699-6478 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: FL PS46979) |
| Enumeration Date | 2012-05-02 |
| Last Update Date | 2012-05-02 |