| NPI | 1710404363 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN LAWRENCE SIMONS Owner 904-476-1816 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS668100) |
| Additional Taxonomies | 207QH0002X Family Medicine, Hospice and Palliative Medicine |
| Enumeration Date | 2017-08-24 |
| Last Update Date | 2022-07-21 |