| NPI | 1447842893 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMEELAH ANDERSON Owner 762-524-2410 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service |
| Additional Taxonomies | 251K00000X Public Health or Welfare |
| Enumeration Date | 2021-02-08 |
| Last Update Date | 2021-02-08 |