| NPI | 1962677260 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH L PATE Director 772-344-4890 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: FL CH 9533) |
| Enumeration Date | 2008-04-28 |
| Last Update Date | 2008-07-11 |