| NPI | 1962269696 |
|---|---|
| Doing Business As | LISA MARIE MALLORY PETERSEN |
| Entity Type | Organization |
| Authorized Contact | LISA PETERSEN Owner 180-287-1082 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2024-02-29 |
| Last Update Date | 2024-02-29 |