| NPI | 1255874566 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW J NELSON Owner 678-650-8779 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: GA CSW005943) |
| Enumeration Date | 2016-11-18 |
| Last Update Date | 2016-11-18 |