| NPI | 1477394369 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHARI COX Director 463-206-9070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2024-06-04 |
| Last Update Date | 2026-04-23 |