| NPI | 1942481429 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLISON DASTA BUTLER Owner 904-282-4565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: FL ME 97725) |
| Enumeration Date | 2007-11-26 |
| Last Update Date | 2009-05-12 |