| NPI | 1962898387 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN RYAN JONES Owner 385-528-2950 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: UT LIC201500969) |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2015-11-09 |