| NPI | 1902663735 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE MANUCY Office Manager 904-615-1794 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 261QH0100X Clinic/Center, Health Services | |
| Enumeration Date | 2024-02-28 |
| Last Update Date | 2024-11-11 |