| NPI | 1790772317 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICE RIGDON Chief Financial Officer 904-953-0577 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2021-04-12 |