| NPI | 1063877538 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONCEPCION MATA ANDRIJESKI Owner 682-203-7096 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: TX 17140) |
| Enumeration Date | 2015-12-28 |
| Last Update Date | 2015-12-28 |