| NPI | 1104175439 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSE FLORES Account Specialist 754-201-2265 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2012-08-31 |
| Last Update Date | 2018-05-15 |