| NPI | 1740860238 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KHAIRIYA C BRYANT Credentialing Consultant 850-339-1359 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Enumeration Date | 2021-04-09 |
| Last Update Date | 2021-04-09 |