| NPI | 1770978140 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JODI S GREEN Office Manager 904-446-9191 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center Medical Specialty (Licence: FL ME62420) |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2015-04-02 |