| NPI | 1770911786 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GWENDOLYN DENISE SHEPPARD Program Supervisor 850-997-3958 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: FL 101ym0800x) |
| Enumeration Date | 2013-10-30 |
| Last Update Date | 2013-10-30 |