| NPI | 1467762567 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFRIE WAGNER Clinical Consultant/Bod 808-221-8994 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: HI 127) |
| Enumeration Date | 2010-10-08 |
| Last Update Date | 2010-11-19 |