| NPI | 1477786226 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAM W SPEAR Executive Director 924-444-8168 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2251C2600X |
| Additional Taxonomies | 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
| Enumeration Date | 2009-08-27 |
| Last Update Date | 2011-11-03 |