| NPI | 1558778779 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON MERKLEY Outpatient Program Supervisor 904-794-0268 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251K00000X Public Health or Welfare (Licence: FL 07-1582-000-05) |
| Enumeration Date | 2014-07-21 |
| Last Update Date | 2014-07-21 |