| NPI | 1184405169 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY DUNNING Credentialing And Contracting Manag 567-377-6316 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2023-10-06 |
| Last Update Date | 2023-10-06 |