| NPI | 1528568615 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINE MARIE ETZRODT Owner 267-229-6237 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: PA PS018437) |
| Enumeration Date | 2018-02-15 |
| Last Update Date | 2019-02-02 |