| NPI | 1679994198 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTI ALEXANDER-DAVIDSON Executive Director 866-563-7772 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: TN 6151932) |
| Enumeration Date | 2013-12-31 |
| Last Update Date | 2013-12-31 |