| NPI | 1376974543 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WALTER HARRIS Owner 252-717-5717 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: LA 10241206#EGG62) |
| Enumeration Date | 2013-12-12 |
| Last Update Date | 2013-12-12 |