| NPI | 1669849246 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA LEE WOOD-CLARK Owner 641-745-0499 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IA 001613) |
| Enumeration Date | 2015-08-30 |
| Last Update Date | 2021-03-09 |