| NPI | 1346935848 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH R EATHERLY Owner 580-320-5633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2023-04-10 |
| Last Update Date | 2023-04-10 |