| NPI | 1700120425 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANE MILLER LUNN President/CEO 850-385-4494 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2012-11-19 |
| Last Update Date | 2020-12-10 |