| NPI | 1588295752 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD GILBERT WATSON Owner/Provider 850-353-7689 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center Rural Health |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2020-01-28 |
| Last Update Date | 2024-02-09 |