| NPI | 1871215129 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JON ELAM Owner 606-207-6617 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2022-09-14 |
| Last Update Date | 2022-09-14 |