| NPI | 1366834160 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YADIRA BAEZ-LOCKARD Owner 864-220-9115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: SC 1337) |
| Enumeration Date | 2015-03-03 |
| Last Update Date | 2016-08-09 |