| NPI | 1164853750 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DREW EDWARDS Billing Manager 754-201-3980 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: 1550AD443401) |
| Enumeration Date | 2013-12-06 |
| Last Update Date | 2013-12-06 |