| NPI | 1962371310 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEONARDA M GAIGE Owner 863-334-9037 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2025-11-03 |
| Last Update Date | 2025-11-25 |