| NPI | 1639461312 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERARD V SPRAGUE Clinical Supervisor 239-332-8009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL 1063528560) |
| Enumeration Date | 2011-05-12 |
| Last Update Date | 2011-05-12 |