| NPI | 1386937159 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIKA S LEWIS Owner 770-500-5062 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic (Licence: GA 10109m) |
| Enumeration Date | 2011-05-26 |
| Last Update Date | 2011-05-26 |