| NPI | 1285801589 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEESA NELSON Executive Director 682-225-1441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QM2800X Clinic/Center, Methadone Clinic |
| 251S00000X (Licence: TX 756H) | |
| Enumeration Date | 2008-05-15 |
| Last Update Date | 2021-07-12 |