NPI | 1447660295 |
---|---|
Entity Type | Organization |
Authorized Contact | JENAI DANELLE TIDWELL Owner 317-523-9275 |
Organization Subpart ? | No |
Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: TX 69448) |
Enumeration Date | 2014-05-02 |
Last Update Date | 2014-05-02 |