| NPI | 1396290060 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRENT JACKSON Director Of Alternate Care 800-710-9348 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2016-08-23 |
| Last Update Date | 2016-08-23 |