| NPI | 1659624765 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE LYNN KRAUSE Office Manager 904-262-3706 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL me0045962) |
| Enumeration Date | 2012-10-26 |
| Last Update Date | 2012-11-09 |