| NPI | 1730040965 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NORGE GARCIA Manager 239-292-0252 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2025-11-18 |
| Last Update Date | 2025-12-11 |