| NPI | 1578002606 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH ROBERT JEFFERSON Owner 619-980-9549 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: WI 1031124) |
| Enumeration Date | 2017-02-22 |
| Last Update Date | 2017-02-22 |