| NPI | 1649644006 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL MARIANO Practice Administrator 941-302-2426 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL me124586) |
| Enumeration Date | 2015-11-23 |
| Last Update Date | 2015-11-23 |