| NPI | 1003320524 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINA L KARDANOW Clinician 239-307-8038 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL 11649) |
| Enumeration Date | 2017-11-20 |
| Last Update Date | 2017-11-20 |