| NPI | 1225560410 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | INFANTA CHANTEL WHITE Owner 228-697-7280 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MS 2104) |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2022-07-21 |