| NPI | 1669689121 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA LITTLEJOHN GONZALES Md 850-477-5475 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: FL ANT3306292) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2020-08-22 |