| NPI | 1386178838 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER ALLEN CONNER Owner 407-810-8319 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL IMH14125) |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2017-04-11 |