| NPI | 1669053351 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN PAUL SHADDOCK Strategy And Development Officer 850-341-6322 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2021-04-15 |
| Last Update Date | 2021-08-05 |