| NPI | 1790283695 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATONYA SMITH Medical Provider 321-437-3715 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251B00000X Case Management |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2018-01-25 |
| Last Update Date | 2022-02-01 |