| NPI | 1902670870 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KO SAN CHAN Manager 615-609-5763 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2023-11-13 |
| Last Update Date | 2024-01-25 |