| NPI | 1568994259 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEIGH ANN HARVEY Director 681-207-7105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine |
| 261QM2500X Clinic/Center, Medical Specialty | |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2022-12-01 |