| NPI | 1790736502 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONY A WEAVER Owner 850-552-0608 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: FL 1240) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2022-05-31 |