| NPI | 1174387195 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACEY ODISHOO Owner 779-356-4095 |
| Organization Subpart ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2024-02-09 |
| Last Update Date | 2024-09-16 |