| NPI | 1891188173 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA ANN BENEDICT Billing Manager 904-230-5437 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL ne74170) |
| Enumeration Date | 2015-03-11 |
| Last Update Date | 2015-03-11 |