| NPI | 1104136647 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTINA TETRICK Owner 407-929-6821 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL MH7529) |
| Enumeration Date | 2010-10-18 |
| Last Update Date | 2011-03-31 |