| NPI | 1417314121 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYRONZA WESLEY Owner 469-486-0772 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 251B00000X Case Management |
| Enumeration Date | 2016-01-26 |
| Last Update Date | 2016-03-11 |