| NPI | 1891413092 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIA JACKSON CFO 407-351-7080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center Methadone |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 3336C0002X Pharmacy Clinic Pharmacy | |
| Enumeration Date | 2022-08-15 |
| Last Update Date | 2023-05-16 |