| NPI | 1174073027 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENE DEL SOLE Owner 863-452-0710 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2016-10-04 |