| NPI | 1417214297 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN COLLISON Billing Coordinator 754-201-2265 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2012-10-31 |