| NPI | 1184998817 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERIE LARRMARR LESEUR Owner 888-685-7709 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: TX 801529643) |
| Enumeration Date | 2012-02-27 |
| Last Update Date | 2012-02-27 |