| NPI | 1245815323 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ARIEL SANTOS Owner 813-610-5449 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2021-03-10 |
| Last Update Date | 2022-04-04 |