| NPI | 1245694777 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETHANY POWELL Owner, Sole Practitioner 361-947-1518 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: CO CHR.0007376) |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2016-04-11 |