| NPI | 1255639720 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ZOYA GORNOPOLSKY Owner 252-331-2174 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NC mhl-070-057) |
| Enumeration Date | 2011-03-08 |
| Last Update Date | 2011-07-25 |