| NPI | 1508290099 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEE TISON WADE Ower 229-244-5533 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: GA 004567) |
| Enumeration Date | 2013-09-03 |
| Last Update Date | 2013-09-03 |