| NPI | 1134581028 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBORAH WILSON Manager 901-871-9062 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MS 0837) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: AR P0510066) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2016-03-22 |