| NPI | 1811266943 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOUIS B FOWLER Owner 850-433-9391 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: FL ME33553) |
| Enumeration Date | 2011-12-19 |
| Last Update Date | 2011-12-19 |