| NPI | 1003045667 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOENE FARRIS NICOLAISEN Executive Director 888-328-5486 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: UT 50526596004) |
| Enumeration Date | 2009-07-03 |
| Last Update Date | 2009-07-03 |