| NPI | 1013415496 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA C ROBERSON Compliance Director 667-239-3263 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2018-01-31 |
| Last Update Date | 2018-01-31 |