| NPI | 1912365172 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLINT TOLMAN Administator 954-634-4425 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: UT 20785) |
| Enumeration Date | 2016-02-03 |
| Last Update Date | 2016-02-03 |