| NPI | 1730549817 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY MIRABILE Medical Doctor 904-342-5965 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: FL ME88707) |
| Enumeration Date | 2016-03-02 |
| Last Update Date | 2016-03-02 |