| NPI | 1841709573 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE K WINN Manager 772-201-7892 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2017-09-26 |
| Last Update Date | 2017-09-26 |