| NPI | 1104649946 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRILL VESSELOV Manager 561-556-3721 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2024-10-31 |
| Last Update Date | 2024-12-06 |