| NPI | 1912364068 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEN CHINWEZE Owner 318-828-1455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: LA 101ym0800x) |
| Enumeration Date | 2016-01-20 |
| Last Update Date | 2016-01-20 |