| NPI | 1902219041 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WHITNEY M GREEN Medical Assistant 850-274-9985 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: GA L7Q7F4B8) |
| Enumeration Date | 2014-06-06 |
| Last Update Date | 2014-06-06 |