| NPI | 1679850481 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDEN MARIE MATTHEWS Assistant 251-269-5936 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: AL 1621C) |
| Enumeration Date | 2011-11-08 |
| Last Update Date | 2011-11-08 |