| NPI | 1366954034 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEILANI DIANE MASON Owner 251-333-2777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251K00000X Public Health or Welfare (Licence: AL 3629C) |
| Enumeration Date | 2017-11-02 |
| Last Update Date | 2024-04-01 |