| NPI | 1659743235 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERI SIDDELL Office Manager 229-226-0741 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL PY9289) |
| Enumeration Date | 2015-10-22 |
| Last Update Date | 2015-10-22 |