| NPI | 1881134088 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD GONZALEZ Provider 239-530-3132 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL SW14345) |
| Enumeration Date | 2017-03-07 |
| Last Update Date | 2020-09-30 |