| NPI | 1003116435 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK G. FERGUSON Director 321-662-3554 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL 230332) |
| Enumeration Date | 2010-11-02 |
| Last Update Date | 2010-11-02 |