| NPI | 1184097578 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTIE B MINGO Owner 813-531-1545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL A232011APD014) |
| Enumeration Date | 2015-11-05 |
| Last Update Date | 2015-11-05 |