| NPI | 1508520941 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AQUARIUS S CARD CEO 678-558-2467 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2021-10-22 |
| Last Update Date | 2021-10-22 |