| NPI | 1891167771 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELI KORNMILLER Senior Credentialing Specialist 561-672-8345 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL 2036AD6563-01) |
| Enumeration Date | 2015-10-30 |
| Last Update Date | 2015-10-30 |