| NPI | 1376836924 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS IRVING Quilified Professional 704-404-0008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: SC 5966) |
| Enumeration Date | 2011-05-16 |
| Last Update Date | 2011-05-16 |