| NPI | 1578938684 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CANDICE L KENNEDY Owner 904-323-0954 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2015-12-01 |
| Last Update Date | 2024-03-20 |