| NPI | 1679937122 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM HOLTZ Case Manager 888-757-1951 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: DE MT-0004006) |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2016-04-11 |