| NPI | 1447603782 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON EGG Owner 812-449-7367 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IN 34006712A) |
| Enumeration Date | 2016-07-21 |
| Last Update Date | 2016-07-21 |