| NPI | 1043631112 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DREW EDWARDS Office Manager 754-201-3980 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2013-12-17 |
| Last Update Date | 2013-12-17 |