| NPI | 1528445509 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER LEE ORMAN Owner 662-295-6015 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MS 11417301) |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2023-10-17 |