| NPI | 1457729345 |
|---|---|
| Doing Business As | GREG |
| Entity Type | Organization |
| Authorized Contact | GREGORY DAVID WOLF Owner 904-571-5678 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2015-09-09 |
| Last Update Date | 2015-09-09 |