| NPI | 1417362401 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MODESTA VAN DEN BOGAARD Licensed Massage Therapist 915-588-2167 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: TX 101448) |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2014-06-27 |