| NPI | 1124997580 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELL MCCLUE President 346-552-1623 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2025-11-04 |
| Last Update Date | 2025-11-04 |