| NPI | 1124534342 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACLYN SHEDDEN Director Of Clinical Services 833-939-3553 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: FL 0S10018) |
| Enumeration Date | 2017-12-26 |
| Last Update Date | 2017-12-26 |