| NPI | 1891250718 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEAN MARIE GOLDTHWAIT Owner 315-744-0765 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-02-05 |
| Last Update Date | 2019-02-05 |