| NPI | 1346691300 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNA L WAZ Owner 475-559-2446 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: CT 1-10-7692) |
| Enumeration Date | 2016-06-30 |
| Last Update Date | 2016-06-30 |