| NPI | 1992844351 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINE BAIN Billing Supervisor 904-276-5700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL me0069445) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2019-08-28 |