| NPI | 1235465550 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON RYAN CANNON President 610-742-1679 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 1417-05-001) |
| Enumeration Date | 2009-10-21 |
| Last Update Date | 2009-10-21 |