| NPI | 1730315706 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAULINE HARRELSON Office Manager 904-356-0072 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 2639) |
| Enumeration Date | 2009-06-04 |
| Last Update Date | 2009-06-04 |