| NPI | 1194334425 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXIS MARIE ALEXANDRA BURGESS Owner 407-801-2242 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-07-22 |
| Last Update Date | 2020-07-22 |