| NPI | 1770930026 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAKINA DESHAZOR Office Manager 267-239-0770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: GA 044-281-D) |
| Enumeration Date | 2016-05-17 |
| Last Update Date | 2016-05-18 |