| NPI | 1003384686 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE WATKINS Manager, Payer Services 346-318-4941 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2024-07-01 |