| NPI | 1649692344 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EUGENE SISCO Administrator 606-437-0097 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: KY 810148) |
| Enumeration Date | 2014-01-15 |
| Last Update Date | 2014-01-15 |