| NPI | 1437607553 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HOLLY L P CANNARD Owner 970-209-5371 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WA LH60647512) |
| Enumeration Date | 2016-09-18 |
| Last Update Date | 2016-09-18 |