| NPI | 1891161154 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK P KOTLARZ Authorized Official/Owner 850-471-2377 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2015-08-20 |
| Last Update Date | 2015-08-20 |