| NPI | 1558768283 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB ALAN WOOTEN President 385-223-4257 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: UT 9167751-1202) |
| Enumeration Date | 2014-11-24 |
| Last Update Date | 2023-09-29 |