| NPI | 1801322078 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAKISHA TIFFANY INGRAM Vice President/Administrator 731-736-1109 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2017-05-10 |
| Last Update Date | 2017-05-11 |