| NPI | 1235125055 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY F. COLE Executive Director 276-964-6702 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| 347C00000X Private Vehicle | |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2024-03-21 |