| NPI | 1912335217 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM L VIRTUE Owner 1208-734-5230 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2013-10-23 |
| Last Update Date | 2013-10-23 |