| NPI | 1902653884 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICIA GROTH Credentialing Manager 904-256-2754 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2024-04-30 |
| Last Update Date | 2025-07-14 |