| NPI | 1114457371 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FENORRIS PEARSON Authorized Official 979-849-1747 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 208D00000X General Practice |
| 261QM2800X Clinic/Center, Methadone Clinic | |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2022-03-02 |