| NPI | 1336676469 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER KOON Owner 315-430-4070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2017-05-19 |
| Last Update Date | 2017-05-19 |