| NPI | 1639540560 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN GAMBOL C.E.O 850-233-2228 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA g87090) |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2015-10-19 |
| Last Update Date | 2015-10-30 |