| NPI | 1932475167 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONIQUE COLEMAN HAMID Owner 904-505-0575 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL MA36322) |
| Enumeration Date | 2012-04-02 |
| Last Update Date | 2012-04-02 |