| NPI | 1134670532 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN S VOLD Owner 641-420-0217 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: IA G127881) |
| Enumeration Date | 2016-10-20 |
| Last Update Date | 2016-10-20 |