| NPI | 1144613787 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFERY TUCK SKINNER Project Manager/Administrator 850-624-6022 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2015-03-06 |
| Last Update Date | 2015-03-06 |