| NPI | 1548426638 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRED CARTER WILSON Manager 904-805-0099 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME42368) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH007302) |
| Enumeration Date | 2008-07-29 |
| Last Update Date | 2017-11-07 |