| NPI | 1245620327 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LA TOYA SHARNETT GREGORY Executive Director 386-253-9391 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: FL 0764AD478701) |
| Enumeration Date | 2015-01-28 |
| Last Update Date | 2015-01-28 |