| NPI | 1427313873 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER ROSARIO Behavioral Counselor 386-215-7830 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2012-07-11 |