| NPI | 1992073738 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANCE A PATE Owner 904-509-7100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0400X Clinic/Center, Rehabilitation (Licence: TN 672988) |
| Enumeration Date | 2011-12-07 |
| Last Update Date | 2011-12-10 |