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 |