| NPI | 1639437569 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUIS ANDERSON Md/President/Owner 904-479-9501 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 208000000X Pediatrics |
| Enumeration Date | 2012-04-28 |
| Last Update Date | 2020-02-14 |