| NPI | 1619240678 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VALERIE MARY NEWMAN Office Administrator 904-332-2525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: FL PY6209) |
| Enumeration Date | 2012-02-21 |
| Last Update Date | 2012-02-21 |