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1513 Chatham Ct St Augustine FL 32092-5050 | |
| (904) 571-5678 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1513 Chatham Ct, St Augustine, Florida |
| Authorized Official Name and Position | Gregory David Wolf (OWNER) |
| Authorized Official Contact | 9045715678 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1513 Chatham Ct St Augustine FL 32092-5050 Ph: (904) 571-5678 | 1513 Chatham Ct St Augustine FL 32092-5050 Ph: (904) 571-5678 |
| NPI Number | 1457729345 |
|---|---|
| Provider Enumeration Date | 09/09/2015 |
| Last Update Date | 09/09/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457729345 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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