| NPI | 1720511991 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN JOHN POTTER Clinical Director 722-458-3457 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2021-04-26 |