| NPI | 1629365705 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VALERIA BRODERICK Owner 678-927-7332 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: GA 031011481) |
| Enumeration Date | 2011-07-08 |
| Last Update Date | 2011-07-08 |