| NPI | 1467998104 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANIEKA GENTLES Owner 774-242-0312 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MA 9499) |
| Enumeration Date | 2017-01-18 |
| Last Update Date | 2017-01-18 |