| NPI | 1619920642 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY MCMICHAEL Member 850-862-7070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: FL HCC4489) |
| Additional Taxonomies | 261QR0200X Clinic/Center, Radiology (Licence: FL HCC4489) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2020-08-22 |