| NPI | 1366101479 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AIME MUKURA LINDA MINEGA SHABANI Manager 855-895-0261 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2021-12-16 |
| Last Update Date | 2021-12-16 |