| NPI | 1124493804 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYRENIA OCTAVIA CROSS Owner 904-699-6342 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL MH13677) |
| Enumeration Date | 2015-12-07 |
| Last Update Date | 2015-12-07 |