| NPI | 1912559675 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHAN IDRIS MAMBAZO Owner/Primary Provider 334-625-9617 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2019-07-12 |
| Last Update Date | 2021-03-12 |