| NPI | 1033467600 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANET LICIAGA Director 407-369-9482 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL 0948AD803001) |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2012-08-29 |