| NPI | 1437774809 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM BODILY Owner 064-209-8747 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2020-06-11 |
| Last Update Date | 2025-03-31 |