| NPI | 1922757558 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIORGI LOPEZ SURI Owner 904-862-6070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2022-03-21 |
| Last Update Date | 2022-03-28 |