| NPI | 1790299329 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD BARRY BOLIN Principal Owner 256-399-9834 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: AL 3191) |
| Enumeration Date | 2017-11-17 |
| Last Update Date | 2017-11-17 |