| NPI | 1376976829 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GWEN ANN MUNDORF Owner/Director 321-615-0990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL SW10736) |
| Enumeration Date | 2013-08-19 |
| Last Update Date | 2014-07-27 |