| NPI | 1609563097 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY DAVIS Revenue Cycle Manager 872-235-0258 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-04-18 |
| Last Update Date | 2023-04-18 |