| NPI | 1962867762 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIA L JONES CEO 904-253-1069 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: FL N04000004094) |
| Enumeration Date | 2015-12-21 |
| Last Update Date | 2020-09-09 |