| NPI | 1033521026 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JODI L OLMSTEAD Owner 772-224-1294 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL LM12574) |
| Enumeration Date | 2014-05-24 |
| Last Update Date | 2014-05-24 |