| NPI | 1821060898 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA FUQUA Administrator 850-219-7603 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: FL 800000042) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2020-05-15 |