| NPI | 1598133563 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERYL LYNETTE SMITH Owner 904-304-5339 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: FL P234782) |
| Enumeration Date | 2015-09-09 |
| Last Update Date | 2015-09-09 |