| NPI | 1619277720 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAL WALLACE B Ca Ba 305-213-2845 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL 0020585) |
| Enumeration Date | 2010-10-25 |
| Last Update Date | 2010-10-25 |