| NPI | 1841211018 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIA CONCEPCION CONNOR Credrentialing 904-824-8088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS5712) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2020-03-13 |