| NPI | 1164839478 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVORY MAYHORN Executive Director 800-596-1250 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 57323) |
| 111N00000X Chiropractor (Licence: TX 9035) | |
| Enumeration Date | 2014-07-18 |
| Last Update Date | 2014-07-18 |