| NPI | 1992110654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JON CLAUDE THOMAS Doctor/Owner 904-683-8177 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: FL CH11201) |
| Enumeration Date | 2014-06-21 |
| Last Update Date | 2014-06-21 |