| NPI | 1902205628 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERYL DONALDSON Principle 6304-141-6722 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: KS 843) |
| Enumeration Date | 2014-08-19 |
| Last Update Date | 2014-08-19 |