| NPI | 1578892485 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY A ROBINSON Administrator 904-768-8350 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: MI 59062583) |
| Enumeration Date | 2009-12-24 |
| Last Update Date | 2009-12-24 |