| NPI | 1518979483 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE ARLENE WALLS Apn 870-777-2191 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251K00000X Public Health or Welfare (Licence: AR A01564 ANP) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2020-08-22 |