| NPI | 1639805500 |
|---|---|
| Former Legal Business Name | TABIA KEONNA WOOLFORK RECREATIONAL MENTAL HEALTH FITNESS FACILITY |
| Entity Type | Organization |
| Authorized Contact | PEGGIE LEE HATTEN Founder 334-647-1880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Enumeration Date | 2022-07-25 |
| Last Update Date | 2022-07-25 |