| NPI | 1558686170 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE MARIE FETCHO Office/Billing Manager 772-335-9808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: FL 1956ad091301) |
| Enumeration Date | 2010-04-07 |
| Last Update Date | 2020-06-10 |