| NPI | 1568670297 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA STANLEY Office Manager 904-777-4990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME0055583) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME0055711) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2020-08-22 |