| NPI | 1962760512 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORRAINE BROKAW Manager 772-781-0219 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: FL sw9906) |
| Enumeration Date | 2012-05-01 |
| Last Update Date | 2012-05-01 |