| NPI | 1558694422 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GORDON B GARVER Mgrm/Member 904-213-1776 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty |
| 261QP2300X Clinic/Center Primary Care | |
| Enumeration Date | 2009-09-10 |
| Last Update Date | 2009-09-11 |