| NPI | 1609616291 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL DAVID STANNARD Administrator 850-509-7567 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2024-05-30 |
| Last Update Date | 2024-05-30 |