| NPI | 1629250915 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARSHA DONALDSON Vice President 904-376-3703 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine |
| Enumeration Date | 2007-11-29 |
| Last Update Date | 2023-11-27 |