| NPI | 1639395197 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY J STOCK Owner 228-831-9400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MS 13805) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2020-08-22 |