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 |