| NPI | 1639281652 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL WEATHERINGTON Practice Administrator 850-243-0520 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2025-03-10 |