| NPI | 1093173163 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES RANDY INGRAM Owner/Director 214-396-3848 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: TX 72488) |
| Enumeration Date | 2016-02-04 |
| Last Update Date | 2016-02-04 |