| NPI | 1154852747 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ARTENTUS WILSON Owner 704-747-6119 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: AZ CLSG8157) |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2017-03-24 |