| NPI | 1518440619 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIEVES SHELBY Administrator/Owner 682-561-3973 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2018-09-13 |
| Last Update Date | 2020-03-09 |