| NPI | 1174061881 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY JEAN WAGNER Owner 712-259-0851 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IA 00850) |
| Enumeration Date | 2017-02-02 |
| Last Update Date | 2017-02-02 |