| NPI | 1558874297 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID SHOOTS Owner 386-747-2331 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: FL SW6973) |
| Enumeration Date | 2017-11-15 |
| Last Update Date | 2017-11-15 |